Case Study: Periodontal Disease and Cardiovascular Disease

Challenge: A new patient who has neglected dental care for 20 years with a chief complaint of broken teeth and bleeding gums appoints to address his dental concerns.

Background:  A 70-year-old male patient with broken teeth and bleeding gums appoints to our office. His last dental visit was estimated to be 20 years ago. Surprisingly the patient was not experiencing dental pain. The periodontal assessment revealed generalized 4-6 mm pockets with localized 7-9 mm pockets, inflamed and bulbous gingiva with generalized moderate plaque, as well as heavy subgingival and supragingival calculus. Several teeth were planned for extraction along with restorative needs. His typical home care consists of manual brushing twice a day with occasional flossing. Patient education focused on improved daily home care and the importance of the mouth body connection, specifically the connection between periodontal disease and cardiovascular disease. A MyPerioPath® sample was collected on 1/24/2019 for oral bacteria evaluation. The patient exhibited signs of dental anxiety during the diagnosis and treatment planning; however, there was treatment acceptance due to the realization of how his oral health can impact his overall and cardiovascular health. Due to a high blood pressure reading of 175/101 following the diagnosis, all treatment was halted, and he was referred for medical consultation.

Solution: Approximately 1 week following the initial diagnosis and after medical clearance, the patient began periodontal therapy. The MyPerioPath® result report showed high levels of 9 perio-pathogenic bacteria. The blood pressure reading taken prior to the same day full mouth therapy was 142/92. The same day therapy consisted of four quadrants of scaling and root planing, irrigation with chlorohexidine and use of a SIRO diode laser. Home care instruction included brushing twice daily, flossing nightly, and incorporating interdental brushes and a Waterpik™. The MyPerioPath® lab report suggestion of a systemic antibiotic, Metronidazole 500 mg for 8-10 days, was prescribed. The patient was scheduled for a follow-up appointment where a second MyPerioPath® specimen was collected on 5/1/2019.

Resolution: The patient was very compliant with his home care routine and used the systemic antibiotic as prescribed. The second salivary test revealed a 71% reduction in pathogens overall with Aa, Pg and Tf all lowering to undetectable levels.  The patient’s tissue health improved, now stippled and almost a 100% reduction in bleeding. The periodontal probe measurements all decreased to 2-3 mm with just one localized 5 mm on tooth #31 mesial remaining.  The patient’s high blood pressure is now medication controlled. His medical doctor attributed the initial elevated reading to dental anxiety. He has remained consistent with follow up periodontal cleanings and his oral health appears to be stable.  It was amazing to see a patient who stayed away from dental care for two decades, because of fear, start to become a routine patient who understood the significance of periodontal disease.

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Shawn Perla RDH

Shawn Perla RDH

Shawn graduated from San Joaquin Valley College; Rancho Cucamonga, CA and has been practicing dental hygiene since 2008. He is laser certified and emphasizes the importance of the mouth body connection through patient education. He is quoted “As my patient, you can feel confident that your oral health is my primary concern. Through high-quality treatment, we will establish and maintain great oral health. My goal is to make the dental office a fun and friendly place my patients look forward to visiting.” In his spare time, he enjoys photography, reading, nature, and most of all, spending time with my wife and two kids.
Shawn Perla RDH

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6 thoughts on “Case Study: Periodontal Disease and Cardiovascular Disease

  1. Thomas Nabors says:

    Shaw,
    An excellent case review. So glad that you included his medical history and waited for his medical eval. So glad too that you are following the OralDNA report as it is intended. The test and Rx recommendation work so well: as you case proves.
    Thomas W. Nabors, DDS, FACD

    1. Shawn Perla says:

      Thank you! Our office truly believes in educating our patients on the mouth body connection. Oral DNA has been an amazing tool to have patients own their disease and make the right changes.

  2. Donn Hassett says:

    Hmm, I thought that the latest research says not to use chlorhexidine for irrigation.

  3. Shawn Perla says:

    Although new research suggests 0.12% chlorohexidine might inhibit fibroblast activity I still utilize it in procedures until further research and the dental community agree to discontinue use with SRPs. The majority of periodontists I have talked with about this topic agree to still use irrigation.

    1. Thomas Nabors, DDS, FACD says:

      Shawn,
      You are wise in continuing to use CHX in your irrigation. The potential for this to inhibit fibroblasts is still over stated. Most of these studies are using in-vitro observation vs. in-vivo. CHX is still used widely in hospital settings due to its safety and effectiveness. And, it is still FDA cleared for use. (unlike most other meds used.) Also, be aware who has the most interest in bad-mouthing CHX. (companies with new products).
      Another point: If CHX inhibited fibroblasts, we would not see alveolar bone growth using non-surgical interventions that we are seeing in many patients. While not the only good medication, it is still a very good one to use.

  4. Dr. Rusznak says:

    Scaling and root planning is frequently referred to as ‘deep cleaning’ which is the treatment of choice for an infectious disease called periodontal disease. If you have this kind of disease, I recommend undergoing deep cleaning instead of regular teeth cleaning.

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